Healthy & Wellbeing host Ed Phillips recently interviewed Dr Phillip Katelaris to discuss urinary incontinence, overactive bladder dysfunction (OAB) and it’s commonality amongst women and children.
|Speaker 1:||Let’s get underway. Why don’t we start with our Sydney Adventist Hospital health check? Thanks to the SAN state-of-the-art healthcare, research, and education, yours for life.|
|[00:00:30]||Well, this one is the problem no one really wants to admit to. However, it’s estimated that over four million Aussies live with urinary incontinence. Due to the aging population, this figure is expected to rise to close to six million by 2030. Sadly, over 70% of people don’t even seek advice despite that fact plenty can be done to improve or cure incontinence. Let’s go to Dr. Philip Katelaris right now, urologist from the Sydney Adventist Hospital, and he’s here for a chat with a focus on male incontinence this afternoon. Good day, doctor.|
|Speaker 2:||Hi, and good afternoon.|
|Speaker 1:||Nice to have you with us. Let’s go and revisit the basics first of, shall we? What is urinary incontinence specifically, medically?|
|Speaker 2:||It is the involuntary loss of urine.|
|Speaker 1:||Simply said.|
Normally, we’re programmed to be able to store urine up to 600 mils comfortably, and go to the toilet at a socially acceptable time. Incontinence is when we can’t store it and when we lose it involuntarily and therefore in an embarrassing way.
|Speaker 1:||All right, so not so much about the storage by I guess the valves for one of a better kind of plumbing analogy that helps us store it.|
Incontinence has two causes. One is a storage problem meaning that the bladder muscle itself is overactive or not functioning properly for any other reason such as nerve damage. Then there is the valve problem or a weak sphincter. Women get a weak sphincter, for example, after childbirth or they may do, not all of them. Men may suffer with sphincter damage after major cancer surgery such as surgery for prostate cancer. Incontinence has two causes, bladder storage or a weak valve or both.
|Speaker 1:||All right. What are the symptoms then we need to get familiar with?|
|Well, if somebody has a bladder storage problem, men and women, they might have frequency, urgency, urgent incontinence, they just can’t hold it, and at the most inappropriate time, it just runs down their leg. Also, that can be combined with needing to get up at night a lot. That’s what we call overactive bladder dysfunction or OAB. Then the symptoms of the weak valve are what’s called stress incontinence meaning if you cough, or laugh, or sneeze, or bend over, or pick up a bag full of groceries, you suddenly feel urine leaking down your leg.|
|Speaker 1:||All right. Who does it effect most commonly, doctor?|
|It affects men and women at different stages, earlier for women, of course, because of childbirth. If women do their pelvic floor exercises before and after childbirth, their incontinence can be minimized, whereas men are more likely to suffer it beyond the age of 50 when prostate problems develop or when they have treatment for prostate cancer.|
|Speaker 1:||All right, what are other things that increase the risk? Are we talking weight, perhaps, or …|
Well, certainly weight will make worse stress incontinence. Men and women with a weak sphincter valve will leak a lot more if they’re overweight. General health advice is very pertinent to the management of urine incontinence. Lose weight, keep fit, and specifically, men and women do pelvic floor exercises.
|Now, that doesn’t fix all people with stress incontinence and the message today is that people don’t have to live with it. We can cure, that is fix completely the vast majority of people, and those in whom we don’t cure, we can usually significantly improve. In men and women, the surgical options are similar where we now are using what are called suburethral sling. These are inserted in a keyhole fashion. They’re success rate is in the order of 80 to 85%.|
|For men, in particular, with very severe incontinence, we have a very clever device known as an artificial urinary sphincter. That’s a hydraulic device, a little cuff around the urethra or water pipe, a little pump in the scrotum. The cuff keeps the urethra closed. It stops the leaking. When the bladder is full and they have the feeling that they want to empty, they simply push these little pump that’s under the skin of the scrotum and that allows the cuff to open the bladder to empty. After two minutes, the cuff automatically refills. The artificial urinary sphincter is a wonderful device to turn around what can be a very incapacitating problem.|
|Speaker 1:||No questions. In the intro, we noted the stat that some 70% of people, perhaps even more don’t even seek advice despite this condition. Are you finding that in your practice?|
|That’s very true. People are embarrassed. They think they’re found silly talking about it. They think it’s an inevitable consequence of getting older. Of course, nothing can be further from the truth. This is a treatable, fixable problem. Often with as I say minimal key-hole surgery, 24 hours in hospital.|
|For the people with overactive bladder disfunction, we now have very good medications. Just take one each night and 85% of people are significantly better. We’re even using Botox injections now into the bladder muscle, which can also work very well to quieten down the bladder muscle and stop the urinary urgency and frequency.|
|Speaker 1:||What’s the medication that’s having such great effect, doctor?|
|They’re bladder calming medications. The most popular one at the moment is a drug called [Budmiger 00:06:19]. That works on the receptor cells in the bladder muscle and it literally decreases the bladder pressure. As you decrease the pressure, you increase the compliance. That, therefore, makes the bladder a low-pressure, high-volume storage organ.|
|Speaker 1:||All righty. Some great options there. Of course, I would imagine, just a handful of lifestyle changes too might help reduce any issues as well.|
|Certainly, things like diabetes can affect bladder control. Controlling diabetes especially at night, high sugar levels over the night will cause a lot of urinary frequency overnight. Excessive drinking of tea, coffee, and alcohol at night can mitigate the need to get up. Treating obstructive sleep apnea can make for a less disturbed sleep pattern overnight. General health issues are always very important.|
|Speaker 1:||Yeah, plenty of options there. Great to shine a light on it, doctor. Appreciate your time.|
|Speaker 2:||You’re welcome.|
|So good to chat. Doctor Philip Katelaris, a urologist at the [inaudible 00:07:29] Sydney Adventist Hospital here on this health check afternoon here at Talking Lifestyle.|